The efficiency of risedronate in reducing bone resorption after total hip arthroplasty: a meta-analysis of randomized control trials at a minimum of 6 months’ follow-up

Abstract

BackgroundRecently risedronate is suggested to be effective for the prevention and treatment of for osteoporosis in total hip arthroplasty. This meta-analysis aimes to evaluate the efficacy of risedronate in reducing femoral periprosthetic bone mineral density loss in patients undergoing primary total hip arthroplasty.MethodsA systematic search was performed in Medline (1966-31 October 2017), PubMed (1966-31 October 2017), Embase (1980-31 October 2017), ScienceDirect (1985-31 October 2017) and the Cochrane Library. Only randomized controlled trial (RCT) were included. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Meta-analysis was performed using Stata 11.0 software. The outcome measures included periprosthetic bone mineral density, length of stay and adverse effects.ResultsFour RCTs including 198 patients met the inclusion criteria. The present meta-analysis showed that there were significant differences between treatment groups in terms of periprosthetic bone mineral density in Gruen zones 1 (standard mean difference (SMD) = 0.758, 95% CI 0.469 to 1.047, P = 0.000), 2 (SMD = 0.814, 95% CI 0.523 to 1.106, P = 0.000), 3 (SMD = 0.340, 95% CI 0.059 to 0.622, P = 0.018), 6 (SMD = 2.400, 95% CI 2.029 to 2.771, P = 0.000), and 7 (SMD = 2.400, 95% CI 2.029 to 2.771, P = 0.000).ConclusionOral risedronate could significantly reduce periprosthetic bone resorption around an uncemented femoral stem (Gruen zones 1, 2, 3, 6, and 7) up to 6 months after THA. In addition, no severe adverse events were identified. Future trials of risedronate treatment after THA should focus on clinically relevant end points such as the risks of fracture and revision arthroplasty.

Letter to the Editor: Oral risedronate increases Gruen zone bone mineral density after primary total hip arthroplasty: a meta-analysis

“…Fourthly, we find that there are another four similar meta-analyses published online in 2018 [5][6][7][8]. All of them were performed following the guideline of PRISMA and four declared that they were the first meta-analysis on this topic, while none of them had a protocol registration in any platform, such as the Cochrane Library and PROSPERO.…”

Bisphosphonates in Total Joint Arthroplasty: A Review of Their Use and Complications

“…[ 27 ] Meta-analysis 56,043 THA 331,660 TKA THA/TKA All bisphosphonates All-cause revision rate Prieto-Alhambra et al. [ 28 ] Case-control meta-analysis 10,524 THA/TKA All bisphosphonates All-cause revision rate Yang [ 29 ] Meta-analysis of RCTs 198 THA Risedronate Bone mineral density Teng [ 30 ] Meta-analysis 31,293 THA/TKA All bisphosphonates All-cause revision rate Zhou et al. [ 31 ] RCT 40 THA Zoledronic acid Bone mineral density Khatod et al.…”

“…found that patients who had osteoporosis and took zoledronic acid had an increase in BMD of 16% over 1 year after THA, compared with patients with osteopenia who lost 10% of their BMD in Gruen zone 1 over the same time period [ 34 ]. Similarly, Yang performed a meta-analysis of 198 THAs followed up for up to 6 months from the index surgery to evaluate the efficacy and safety of oral risedronate on BMD after THA [ 29 ]. These authors concluded that, in an uncemented femoral component, risedronate significantly reduces periprosthetic bone loss up to 6 months after THA, and no severe adverse events occurred.…”

“…Researchers found that the most common side effect observed was low back pain (28.0% vs 37.5%) and was not related to bisphosphonate use. In regard to risedronate, Yang’s meta-analysis also reported no severe adverse events in their study of THAs; however, the follow-up was short (6 months), and thus, monitoring for long-term adverse events must be a priority going forward [ 29 ].…”

Total hip arthroplasty in patients with osteoporosis

“…Several quality studies (including systematic reviews and meta-analyses) have been performed in humans showing the early (up to 2 years) positive effect of the administration of mainly bisphosphonates on the preservation of periprosthetic bone stock, especially in cementless THAs at short to mid-term follow-up. [40][41][42][43][44][45][46][47][48] While pre-and postoperative bone mineral density measurements allow the prediction of mechanical bone quality, their relevance in predicting long-term failure in arthroplasty treatment remains unclear. 11,15 A retrospective cohort study revealed that bisphosphonates users had lower revision rates.…”